Brief English and Spanish Survey Detects Change in Response to Advance Care Planning Interventions

Ying Shi; Deborah E Barnes; John Boscardin; John J You; Daren K Heyland; Aiesha M Volow; Michelle Howard; Rebecca L Sudore

doi:10.1016/j.jpainsymman.2019.09.004

Brief English and Spanish Survey Detects Change in Response to Advance Care Planning Interventions

J Pain Symptom Manage. 2019 Dec;58(6):1068-1074.e5. doi: 10.1016/j.jpainsymman.2019.09.004. Epub 2019 Sep 18.

Authors

Ying Shi¹, Deborah E Barnes², John Boscardin³, John J You⁴, Daren K Heyland⁵, Aiesha M Volow⁶, Michelle Howard⁷, Rebecca L Sudore⁶

Affiliations

¹ Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA. Electronic address: Ying.Shi@ucsf.edu.
² San Francisco Veterans Affairs Health Care System, San Francisco, California, USA; Department of Psychiatry, University of California, San Francisco, California, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA.
³ Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA.
⁴ Departments of Medicine, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
⁶ Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.
⁷ Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.

Abstract

Context: The validated 82-item Advance Care Planning (ACP) Engagement Survey measures a broad range of ACP behaviors but is long.

Objectives: Determine whether shorter survey versions (55-item, 34-item, 15-item, 9-item, and 4-item versions) can detect similar change in response to two well-validated ACP interventions and provide practical effect size information.

Methods: We assessed ACP engagement for 986 English- and Spanish-speaking adults in a randomized trial of PREPARE vs. an advance directive-only study arms. The survey was administered at baseline, one week, three months, six months, and 12 months. We calculated mean change scores from baseline to follow-up time points by study arm, intraclass correlation coefficients of change scores between the 82-item survey with shorter versions, and within-group and between-group effect sizes of the mean change scores.

Results: Shorter survey versions were able to detect within-group and between-group changes at all time points. Within-group intraclass correlations of the 82-item to shorter versions were high (0.78-0.97), and the amount of between-group differences was comparable using all survey versions. Twelve-month within-group effect sizes ranged narrowly from 0.76 to 1.05 for different survey versions in the PREPARE arm and from 0.44 to 0.64 for the advance directive-only version. Between-group effect sizes ranged narrowly from 0.24 to 0.30 for different survey versions. Results were similar when stratified by English and Spanish speakers.

Conclusion: Shorter versions of the ACP Engagement Survey were able to detect within-group and between-group changes comparable with the 82-item version and can be useful for efficiently and effectively measuring ACP engagement in research and clinical settings.

Keywords: Advance care planning; psychometrics; surveys and questionnaires.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adult
Advance Care Planning*
Advance Directives
Aged
Ethnicity
Female
Humans
Language
Male
Middle Aged
Patient Participation
Psychometrics
Socioeconomic Factors
Surveys and Questionnaires*

Grants and funding

K24 AG054415/AG/NIA NIH HHS/United States